Medical Health Services Research Articles

Social Determinants of Health Services Utilization Among Patient with Chronic Diseases Based on the China Health and Retirement Longitudinal Survey

Objective: In a word, the published studies are about health services among different population groups. Moreover, most of these studies focused on the relationship between medical insurance and health services, without utilizing the latest data and large sample sizes. This study aims to evaluate health services and their associated factors among middle-aged and elderly people with chronic diseases in China.

Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040.

Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.

The impact of basic health insurance participation characteristics on the health of mobile populations: the mediating role of health service utilization behavior.

It is a pivotal element of China's health system reform to improve the health security of health insurance for the mobile population. Achieving this objective is integral to the success of the reform. The aim of this study was to analyze the impact of different enrollment characteristics of basic health insurance on the health of the mobile population and to investigate the mediating role of health service utilization behavior. This cross-sectional study included 135,372 migrants who participated in the 2018 China Migrants Dynamic Survey (CMDS). Two indicators were employed in this study to assess the characteristics of the mobile population's involvement in basic health insurance-namely, whether or not they participated in local health insurance and the type of health insurance in which they participated. The health status of the mobile population was measured using self-assessed health. Health service utilization behavior was divided into public health service utilization and medical service utilization. Multivariate ordered logistic regression was employed to examine the effect of health insurance on the health of the mobile population. Subsequently, the Bootstrap method was applied to analyze the mediating effect of health service utilization behavior in the relationship between health insurance and the health of the mobile population. Health insurance had a positive impact on health, public health services, and health service utilization among the mobile population. However, enrollment in local health insurance (OR = 1.088, 95% CI = 1.043-1.134) and enrollment in Basic Medical Insurance for Urban Employees (OR = 1.178, 95% CI = 1.090-1.273) were more likely to be associated with higher levels of health and a greater likelihood of receiving health service utilization. The results of the mediating mechanism analysis indicated that health education, health records, family doctor contracting, receiving inpatient services, and being hospitalized locally all played a partially mediating role in the impact of the place of enrollment on health. Regarding the effect of the type of enrollment on health, three types of services-namely, health education, health records, and contracting with a family doctor-played a partially mediating role, while receiving inpatient services and being hospitalized locally did not exhibit a mediating effect. The effect of the type of participation on health is partially mediated. Based on the impact of the different enrolment characteristics of basic health insurance on the health of the mobile population and the mediating role of health service utilization in this impact, furthermore, improvement of health insurance coverage for the mobile population should focus on improving the accessibility of health services, increasing the level of health insurance coverage, mitigating differences in treatment between the different insurance systems, and simplifying the process of transferring the health insurance relationships.

Dose the increasing burden of social endowment affect sustainable development of economy?

The rapid increase in the number of older people under the background of population aging has gradually changed the disease spectrum of society, making aging diseases more prevalent, and increasing the demand for health care services, medical and health services, and health insurance among older people, ultimately leading to increasing household and social spending on old age. This study is conducted to assess the impact of those spending burden on the sustainable development of economy and find out some practical and effective solutions. This paper constructs a theoretical model to illustrate the relationship between the old-age dependency ratio and the marginal product of capital (MPK), and then establishes a two-way fixed effect model based on transnational panel data of 81 countries from 1981 to 2017 to verify this relationship empirically. This paper finds that, after controlling a series of variables, an increased burden of old-age dependency leads to a decline in the MPK, a key macroeconomic variable and also a sustainable development criteria, but in which health care, health security systems, and technological innovation play a key and moderating role. The conclusion is also valid after tackling the problem of endogeneity with different methods, like two-stage least squares (TSLS) and the generalized methods of moments (GMM). Overall, before population aging, countries that are old-but-not-rich should encourage more supply-side investments in public health system or technological innovation, and adjust retirement system, or gradually encourage childbearing to strive for time and space for later sustainable development of public health system and economy.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of “Very good” or “Good” was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

Donor-funded procurement determinants and effectiveness of procurement in the public health medical laboratory services: Examining the mediating factors

Donor-funded procurement determinants and effectiveness of procurement in the public health medical laboratory services: Examining the mediating factors

Evolutionary trend analysis of the pharmaceutical management research field from the perspective of mapping the knowledge domain.

Pharmaceutical management is a new frontier subject between pharmacy, law and management, and related research involves the whole process of drug development, production, circulation and use. With the development of medical systems and the diversification of patients' drug needs, research in the field of pharmaceutical management is becoming increasingly abundant. To clarify the development status of this field, this study conducted a bibliometric analysis of relevant literature in the field based on the knowledge graph method for the first time and explored the evolutionary trends of research hotspots and frontiers. Literature was obtained from the Web of Science Core Collection database. CiteSpace 6.2.R4 (Advanced), VOSViewer, Scimago Graphica, Pajek and the R programming language were used to visualize the data. A total of 12,771 publications were included in the study. The publications in the field of pharmaceutical management show an overall increasing trend. In terms of discipline evolution, early research topics tended to involve the positioning of pharmacists and pharmaceutical care and the establishment of a management system. From 2000 to 2005, this period tended to focus on clinical pharmacy and institutional norms. With the development of globalization and the market economy, research from 2005 to 2010 began to trend to the fields of drug markets and economics. From 2010 to 2015, research was gradually integrated into health systems and medical services. With the development of information technology, after 2015, research in the field of pharmaceutical management also began to develop in the direction of digitalization and intelligence. In light of the global pandemic of COVID-19, research topics such as drug supply management, pharmaceutical care and telemedicine services under major public health events have shown increased interest since 2020. Based on the knowledge mapping approach, this study provides a knowledge landscape in the field of pharmaceutical management research. The results showed that the reform of pharmacy education, the challenge of drug management under the COVID-19 pandemic, digital transformation and the rise of telemedicine services were the hot topics in this field. In addition, the research frontier also shows the broad prospects of the integration of information technology and pharmaceutical management, the practical value of precision pharmaceutical services, the urgent need of global drug governance, and the ethical and legal issues involved in the application of artificial intelligence technology in drug design, which points out the direction for the future development of pharmaceutical practice.

Donor-funded procurement determinants and effectiveness of procurement in the public health medical laboratory services: examining the mediating factors

Donor-funded procurement determinants and effectiveness of procurement in the public health medical laboratory services: examining the mediating factors

Primary Care - A brief summary that every Cephaliatrist should know

Introduction Primary Health Care (PHC) serves as the foundation of the healthcare system, playing a vital role in disease prevention, treatment, and health promotion. It functions as the first point of contact between patients and the healthcare system, offering comprehensive and continuous care. Objectives The primary objective of this review is to provide an in-depth understanding of PHC, with a focus on its structure, processes, services, and projects, as a basis for potential initiatives related to headache disorders. Methodology The literature review encompassed various sources, including Google Scholar, Scielo, Pubmed/Medline, Lilacs, and government sources. Keywords related to PHC, including topics such as structure, functioning, and services, as well as specific areas like Women's Health, Mental Health, vaccination, and child healthcare, were employed. Results PHC is responsible for coordinating the Regionalized Healthcare Network (RAS), which includes Primary Care, communication centers, secondary and tertiary care points, support systems, and governance. PHC serves as the gateway, providing various services, including women's health, mental health, vaccination, child healthcare, and various other medical services. Furthermore, teams, such as the Family Health Strategy and the Family Health Support Center, play distinct roles in health promotion and care coordination. The focus of PHC includes territorialization, vaccination, wound care, women's health, and child healthcare, with a commitment to interventions and projects aimed at improving the quality of care and achieving positive outcomes. Conclusion PHC can play a crucial role in addressing headache disorders, offering early diagnosis, appropriate management, and the promotion of healthy habits. Investing in programs and professional training within PHC can be essential to provide effective care and reduce the demand for emergency care in cases of headache disorders.

언택트 시대 시각장애인 의료 접근권 개선 방안

The purpose of this study was to review laws related to the right to health for the people with disabilities in Korea, and to identify the health status of people with visual impairment (PVI) and the discrimination or difficulties experienced in the process of using medical and health services. The concept of the right to health stipulated in domestic laws was reviewed, and online survey was used to investigate the health status of PVI. A total of 239 people participated in the survey, and basic health conditions, medical services, and medical support needs were collected from September 5 to October 31, 2022. The research results are as follows. First, an IT-based solution was needed to help PVI understand through voice or enlarged text for taking medication in medical institutions. Second, there is a need to promote the placement of manpower to provide one-stop support for patients with mobility difficulties in tertiary care institutions. Third, it is necessary to provide free support for essential healthcare auxiliary devices with voice or large text input/output functions through health insurance. Fourth, it is necessary to partially subsidize the cost of personal trainers or implement an exercise voucher system. Based on the research results, a plan to support the use of medical and health services and guarantee the right to health of PVI was proposed.

Factors Associated with the Nutritional Status of Children Aged 3 - 5 Years at Hasanuddin Mandai Community Health Center, Mandai District, Maros Regency

Nutritional problems are essentially a public health problem, but overcoming them cannot be done with a medical approach and health services alone. The causes of nutritional problems are multifactorial, therefore the approach to overcoming them must involve various related sectors. Based on data from the South Sulawesi Health Service in 2005, there were 14,650 (3.45%) children under five who were malnourished. Meanwhile, in the city of Maros, there were 463 (2.40%) children under five who were malnourished, and in particular at the Hasanuddin Mandai Community Health Center in 2006 there were 35 (10.17%) children aged 3 - 5 years who were malnourished. This study aims to determine the factors related to the nutritional status of children aged 3 - 5 years at the Hasanuddin Mandai Community Health Center, Mandai District, Maros Regency. The research design used in this research is analytical descriptive using the "Cross Sectional Study" approach method. The sample in this study was 77 children aged 3 - 5 years who were at the location at the time of the research using the Purposive Sample technique . The way to collect data is by taking measurements of the child's weight, then making observations and distributing questionnaires to respondents. To determine the factors related to the nutritional status of children aged 3 - 5 years, the Pearson Chi Square Test was used with a significance level of ? = 0.05 in SPSS version 12. The results of the study showed that there was a significant relationship between the factors of children's diet and mother's knowledge. , maternal occupation and parenting patterns with children's nutritional status, but there is an insignificant relationship between maternal education and family income and nutritional status of children aged 3 - 5 years at the Hasanuddin Mandai Community Health Center, Mandai District, Maros Regency.

Access to health care for Afghan immigrants and refugees: an ethico-legal analysis based on the Iranian health law system.

The right to health is an internationally recognized and established human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country's public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

An investigation of healthcare professionals’ perspectives on the tasks of mental health counselors in hospital settings

AbstractIn this study, we attempted to understand what other healthcare professionals considered mental health counselors’ (MHCs) tasks in their hospital setting to facilitate medical and mental health services and enhance patients’ well‐being. Using an exploratory sequential mixed‐methods design (concept mapping), we obtained 3 regions of MHCs’ tasks (i.e., Overarching Roles and Responsibilities of MHCs in the Hospital Setting, MHCs’ Specific Roles in the Hospital Setting, and MHCs’ Roles and Responsibilities as a Multidisciplinary Team Member) represented in 11 clusters. We discussed the results with implications for MHCs, healthcare professionals, counselor educators, and researchers, along with the current study's limitations.

Abstract A008: Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19

Abstract Cancer is a leading cause of death in the United States especially among racial and ethnic minorities, and other medically underserved populations. Cancer disparities are an important public health issue with health communication implications particularly for African Americans. African Americans have the highest mortality rate and shortest survival rate for most cancers. Reducing the cancer burden depends on early detection through preventative screening and addressing social determinants of health that drive cancer health inequities. Despite the evidence that adherence to providers’ recommendation of cancer screening guidelines decreases incidence and mortality rates, participation in cancer screening remain low among African Americans due to social and economic factors. The reasons for cancer-related health disparities are multifactorial and encompass physician and patient barriers. Medical distrust has emerged as a significant issue impacting cancer prevention especially during the coronavirus disease (COVID-2019) pandemic. Mistrust of the medical and research communities reflects the history of abuse and discrimination in the U.S., and has resulted in disparate health outcomes, as well as less frequent use of preventive health services. It is critical that populations at increased cancer risk have access to trusted, credible cancer health information and medical services to promote adherence to screening recommendations. To address this need, this cross-sectional study will examine the patient-provider communication practices among African American adults receiving primary care in the District of Columbia and their adherence to breast, cervical, colon and prostate cancer screening recommendations during the COVID era. The study is guided by an understanding of the social determinants of health. Specifically, the study will examine the relationship of trust, structural racism, and religiosity on cancer prevention behavior. The project will describe the perceptions of health inequities within the healthcare system and trust in cancer information sources that influence cancer screening behaviors among African Americans. This project is relevant to the reduction of cancer disparities and cancer prevention for African Americans. Patient-provider communication is a known barrier and facilitator of cancer screening behavior where an awareness of historical distrust of medical institutions, systemic racism, and religiosity are important factors in providing culturally appropriate care. The results of this pilot project will be used to inform best practices for patient-provider communication for cancer prevention. Findings will be used to develop culturally tailored interventions to promote compliance for cancer screening during the COVID era and beyond. Citation Format: Finie Hunter-Richardson, Pamela L. Carter-Nolan, Carla D. Williams, Mark S. Johnson. Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A008.

Stunting Analysis In Toddlers In West Java 2014-2021

Stunting in toddlers is a global health problem affecting children's physical andmental development. This study aims to analyze the prevalence, trends, causes, and impact of stunting on toddlers in West Java province from 2014-2021. It also provides poor nutrition, sanitation, and access and healthcare practices. The analysis results show that although preventive and intervention efforts have been undertaken by the government, stunting rates in children under 5 years of age in West Java still remain high during the study period. Bad nutrition, especially bad nutrition in the first 1,000 days of life, was identified as the main cause of stunting in this region. In addition, poor hygiene and lack of access to health care also played a big role in this problem. Stunting has a serious impact on the physical and cognitive development of toddlers and can affect their productivity and health in the future. Therefore, real steps need to be taken to improve good nutritional access, provide education on the importance of nutrition in pregnancy and childhood, as well as improving the health infrastructure and medical services facilities in West Java. This study provides an in-depth understanding of stunting dynamics in children under 5 years of age at the regional level, so that it can serve as a foundation for more effective intervention policies and programs to lower the malnutrition rate.

Understanding healthcare engagement for people who inject drugs.

People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under-treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July-September 2019. Participants were sampled across a range of comorbidities, including co-occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient-provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment,medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient-provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non- stigmatizing manner. Additionally, policy to reimburse wrap-around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID. No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.

Food Insecurity after Cash Transfer Program in Rural Areas of Tehran: A Mixed Method Study

Background: Cash transfer (CT) is one of the strategies used by many developing countries to improve food security and nutritional status of lower socio-economic groups. This study aims to assessing household food insecurity (HFI) and viewpoints of women after CT program in rural population of Tehran province by both quantitative and qualitative methods. Methods: After making arrangements with rural health centers of Shahid Beheshti University of Medical Sciences and Health Services, 250 households were selected from five rural of Iran with different socio-economic status (SES) by cluster sampling. Locally adapted Household Food Insecurity Access Scale (HFIAS), food frequency, and SES questionnaires were completed, and height, weight, and waist circumference of adult females were measured. .Data on families' coping strategies were collected through 7 focus-group discussions. Results: The frequency of mild, moderate, and severe HFI was 22.3, 22.3, and 16.0%, respectively. SES negatively affected HFI (P<0.001), and HFI negatively influenced food-group consumption (P<0.001). Most of the women reported strategies like borrowing from family and friends, skipping meals, and eating less food by mothers. Conclusions: It seems that in spite of CT program, the prevalence of HFI among Iranians in rural areas was relatively high and consumption of food groups in FI households was low.

Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China

BackgroundMedical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments.ObjectivesTo explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach.MethodsThe diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy.ResultsThere were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients.ConclusionsThe capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.

Effects of private health insurance on medical expenditure and health service utilization in South Korea: a quantile regression analysis

BackgroundDespite universal health insurance, South Korea has seen a sharp increase in the number of people enrolled in supplemental private health insurance (PHI) during the last decade. This study examined how private health insurance enrollment affects medical expenditure and health service utilization.MethodsUnbalanced panel data for adults aged 19 and older were constructed using the 2016–2018 Korea Health Panel Survey. Quantile regression for medical cost, and quantile count regression for health service utilization were utilized using propensity score-matched data. We included 17 variables representing demographic, socioeconomic, and health information, as well as medical costs and use of outpatient and inpatient care.ResultsWe discovered that PHI enrollees’ socioeconomic and health status is more likely to be better than PHI non-enrollees’. Results showed that private health insurance had a greater effect on the lower quantiles of the conditional distribution of outpatient costs (coefficient 0.149 at the 10th quantile and 0.121 at the 25th quantile) and higher quantiles of inpaitent care utilization (coefficient 0.321 at the 90th quantile for days of hospitalization and 0.076 at the 90th quantile for number of inpatient visits).ConclusionsPHI enrollment is positively correlated with outpatient costs and inpatient care utilization. Government policies should consider these heterogeneous distributional effects of private health insurance.

Increasing access to quality care for pregnant and postpartum people with opioid use disorder: Coordination of services, provider awareness and training, extended postpartum coverage, and perinatal quality collaboratives

IntroductionFifteen states participating in the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC) developed action plan goals and activities to address the rise in opioid use disorder (OUD) among birthing persons. In a separate initiative, Perinatal Quality Collaboratives (PQCs) from 12 states participating in Centers for Disease Control and Prevention (CDC)-supported activities hosted trainings to improve the provision of OUD services and implement protocols for screening and treatment in delivery facilities. MethodsThis descriptive study synthesizes qualitative data extracted from 15 OMNI LC state action plans, excerpts from qualitative interviews conducted with OMNI LC state teams, and quantitative data from quarterly project performance monitoring reports from 12 CDC-funded PQCs implementing quality improvement activities to address clinical service gaps for pregnant and postpartum people with OUD. Qualitative data were deidentified, coded as barriers or facilitators, then aggregated into emergent themes. Count data are presented for quantitative results. ResultsThe OMNI LC states identified a lack of coordinated care among providers, stigma toward people with OUD, discontinued insurance coverage, and inconsistencies in screening and treating birthing people with OUD as barriers to accessing quality care. State-identified facilitators for access to quality care included: 1) improving engagement and communication between providers and other partners to integrate medical and behavioral health services post-discharge, and facilitate improved patient care postpartum; 2) training providers to prescribe medications for OUD, and to address bias and reduce patient stigma; 3) extending Medicaid coverage up to one year postpartum to increase access to and continuity of services; and 4) implementing screening, brief intervention, and referral to treatment (SBIRT) in clinical practice. PQCs demonstrated that increased provider trainings to treat OUD, improvements in implementation of standardized protocols, and use of evidence-based tools can facilitate access to and coordination of services in delivery facilities. ConclusionState-identified facilitators for increasing access to care include coordinating integrated services, extending postpartum coverage, and provider trainings to improve screening and treatment. PQCs provide a platform for identifying emerging areas for quality improvement initiatives and implementing clinical best practices to provide comprehensive, quality perinatal care for birthing populations.